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A 67-year-old man is brought to the emergency department due to nausea, vomiting, and increasing abdominal pain over the last 3 hours. Four weeks ago he was discharged from the hospital following an inpatient admission for acute myocardial infarction. His other medical problems include type 2 diabetes mellitus, hypertension, hypercholesterolemia, and peptic ulcer disease. The patient quit smoking 2 years ago and does not use alcohol or illicit drugs. His temperature is 37.8 C (100 F) , blood pressure is 150/90 mm Hg, pulse is 110/min and irregular, and respirations are 22/min. The patient appears to be in severe distress due to pain. The chest is clear to auscultation. Bowel sounds are decreased. There is diffuse abdominal tenderness, but it is more pronounced over the lower right quadrant. There is no peripheral edema. Initial laboratory results are as follows: Urinalysis is within normal limits. Which of the following is the most likely diagnosis in this patient?
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